Difference between revisions of "Cochlear implant surgery"

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| considerations_intraoperative = Facial nerve monitoring (avoid paralytics)
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}}'''Cochlear implant surgery''' is a novel surgical approach to address deafness and sensorineural hearing loss. The surgery consists of implanting a cochlear implant device that resides externally and receives and processes sound, and an internal component that transmits the received sound and stimulates the cochlear nerve<ref>{{Cite journal|last=Naples|first=James G.|last2=Ruckenstein|first2=Michael J.|date=2020-02|title=Cochlear Implant|url=https://pubmed.ncbi.nlm.nih.gov/31677740|journal=Otolaryngologic Clinics of North America|volume=53|issue=1|pages=87–102|doi=10.1016/j.otc.2019.09.004|issn=1557-8259|pmid=31677740}}</ref><ref>{{Cite journal|last=Mowry|first=Sarah E.|last2=Woodson|first2=Erika|date=2020-01-01|title=Cochlear Implant Surgery|url=https://pubmed.ncbi.nlm.nih.gov/31556929|journal=JAMA otolaryngology-- head & neck surgery|volume=146|issue=1|pages=92|doi=10.1001/jamaoto.2019.2274|issn=2168-619X|pmid=31556929}}</ref>. This surgery has been applied to post-lingual adults and prelingual children with hearing loss. Typically, during surgery, a 2-channel electrode is used to monitor the upper and lower divisions of the facial nerve. The classical approach is a posterior tympanotomy - used both for adults and children. A suprameatal approach is reserved for patients with anatomical variations.   
}}'''Cochlear implant surgery''' is a novel surgical approach to address deafness and sensorineural hearing loss. The surgery consists of implanting a cochlear implant device that resides externally and receives and processes sound, and an internal component that transmits the received sound and stimulates the cochlear nerve<ref>{{Cite journal|last=Naples|first=James G.|last2=Ruckenstein|first2=Michael J.|date=2020|title=Cochlear Implant|url=https://pubmed.ncbi.nlm.nih.gov/31677740|journal=Otolaryngologic Clinics of North America|volume=53|issue=1|pages=87–102|doi=10.1016/j.otc.2019.09.004|issn=1557-8259|pmid=31677740|via=}}</ref><ref>{{Cite journal|last=Mowry|first=Sarah E.|last2=Woodson|first2=Erika|date=2020-01-01|title=Cochlear Implant Surgery|url=https://pubmed.ncbi.nlm.nih.gov/31556929|journal=JAMA otolaryngology-- head & neck surgery|volume=146|issue=1|pages=92|doi=10.1001/jamaoto.2019.2274|issn=2168-619X|pmid=31556929}}</ref>. This surgery has been applied to post-lingual adults and prelingual children with hearing loss. Typically, during surgery, a 2-channel electrode is used to monitor the upper and lower divisions of the facial nerve. The classical approach is a posterior tympanotomy - used both for adults and children. A suprameatal approach is reserved for patients with anatomical variations.   


==Preoperative management==
==Preoperative management==

Revision as of 13:09, 11 July 2021

Cochlear implant surgery
Anesthesia type

General

Airway

ETT

Lines and access

PIV

Monitors

Standard; facial nerve monitoring

Primary anesthetic considerations
Preoperative

Patients' hearing is limited

Intraoperative

Facial nerve monitoring (avoid paralytics)

Postoperative
Article quality
Editor rating
Unrated
User likes
0

Cochlear implant surgery is a novel surgical approach to address deafness and sensorineural hearing loss. The surgery consists of implanting a cochlear implant device that resides externally and receives and processes sound, and an internal component that transmits the received sound and stimulates the cochlear nerve[1][2]. This surgery has been applied to post-lingual adults and prelingual children with hearing loss. Typically, during surgery, a 2-channel electrode is used to monitor the upper and lower divisions of the facial nerve. The classical approach is a posterior tympanotomy - used both for adults and children. A suprameatal approach is reserved for patients with anatomical variations.

Preoperative management

Patient evaluation

  • Patients' limited hearing may impair preoperative consultation

Operating room setup

  • Standard GA setup
  • Consider straight connector with accordion to ETT
  • Circuit extensions for 180-degree supine position


Intraoperative management

Monitoring and access

  • Facial nerve monitoring
  • PIV (consider 2nd IV in lower extremity with 180-degree positioning)

Induction and airway management

  • GETA

Positioning

  • 180-degree turn (head is away from anesthesia team)
  • Head positioned away from operating site.
  • Surgeons may conduct frequent head position changes intraoperatively

Maintenance and surgical considerations

  • Avoid paralytics to maintain facial nerve monitoring. Consider high-depth of anesthesia or remifentanil infusion
  • During microscopy, minimize patient movement
  • Volatile anesthetics are appropriate despite facial nerve monitoring

Emergence

Postoperative management

Disposition

  • PACU
  • Home discharge

Pain management

  • Oral narcotics
  • Multi-modal, non-narcotic medications

Potential complications

  • PONV

Procedure variants

Posterior

Tympanotomy

Suprameatal
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References

  1. ↑ Naples, James G.; Ruckenstein, Michael J. (2020). "Cochlear Implant". Otolaryngologic Clinics of North America. 53 (1): 87–102. doi:10.1016/j.otc.2019.09.004. ISSN 1557-8259. PMID 31677740.
  2. ↑ Mowry, Sarah E.; Woodson, Erika (2020-01-01). "Cochlear Implant Surgery". JAMA otolaryngology-- head & neck surgery. 146 (1): 92. doi:10.1001/jamaoto.2019.2274. ISSN 2168-619X. PMID 31556929.

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